Healthcare Provider Details

I. General information

NPI: 1720203086
Provider Name (Legal Business Name): DR TANVEER AHMAD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BLAKELY ST SUITE A
WOODSTOCK IL
60098-3713
US

IV. Provider business mailing address

335 BLAKELY ST SUITE A
WOODSTOCK IL
60098-3713
US

V. Phone/Fax

Practice location:
  • Phone: 815-338-0900
  • Fax: 815-338-5390
Mailing address:
  • Phone: 815-338-0900
  • Fax: 815-338-5390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036072630
License Number StateIL

VIII. Authorized Official

Name: DR. TANVEER AHMAD
Title or Position: OWNER
Credential: MD
Phone: 815-338-0900